​Dermatology - Irritant Contact Dermatitis (ICD)

​Dermatology - Irritant Contact Dermatitis (ICD)
ICD is the result of chemical irritants and can occur after either a single or repeated exposure. It is influenced by the concentration of the irritants and happens when the exposure over a specific threshold. Allergic contact dermatitis, on the other hand, is contingent upon sensitization. The most frequent occurrence of ICD is related to one's employment, however exposure can happen in any setting. The predominant agents include abrasives, cleaning compounds, oxidizing agents, reducing agents, plant and animal enzymes, dessicants, dust, soil, and excessive water.

The symptoms of ICD manifest in the specific area of the body that has been exposed, resulting in a sensation of burning, stinging, and itching that can start between seconds to hours after the exposure. Severe irritants elicit a reaction during brief exposure, however the majority of cases result from prolonged and cumulative exposure.
Abnormalities
The observed erythema and superficial edema are well-defined and do not extend beyond their current boundaries. These symptoms are consistent with exposure.
In severe situations, vesicles and blisters may develop and progress to erosions or complete necrosis. The lesion's pattern frequently exhibits an unconventional or straight-line configuration, which is associated with the contact pattern. The duration of lesions in acute ICD typically ranges from a few days to a few weeks. Chronic ICD is characterized by persistent redness, itching, and a burning sensation, which result in continuous rubbing and the development of thickened skin with scales, indistinct boundaries, and lichenification that can last for months to years.

The diagnosis is established through a thorough analysis of the patient's medical history and a comprehensive clinical examination. Allergic contact dermatitis is the primary differential diagnosis of utmost significance. The differential diagnosis for skin conditions on the palms and soles includes palmoplantar psoriasis and photoallergic contact dermatitis in areas that are exposed to sunlight. Administer topical glucocorticoids and provide pain treatment as necessary.


Determine and eliminate the causative agent, followed by the application of wet dressings soaked in Burow's solution, to be changed at intervals of 2-3 hours. Empty the bigger vesicles by draining their contents, but do not take off the tips. Counsel patients on methods to prevent exposure, such as utilizing protective gear, barrier creams, and considering a change in occupation.
Manage lesions by applying topical glucocorticoids such as betamethasone dipropionate or clobetasol propionate. Additionally, ensure sufficient lubrication, which should be sustained throughout the healing process while progressively reducing the use of glucocorticoids.